Pain management for planned surgery

[Music] 

[Text on screen: Enhanced Recovery After Surgery (ERAS) Surgery School]

[Text on screen: Traditional Custodians of Country - The Health Service Partnership would like to acknowledge the many Traditional Custodians of Country throughout Australia, with the filming of this video taking place on the Wurundjeri and Boonwurrung land of the Kulin Nation. We honour their Elders past, present and emerging, and extend that respect to any First Nations, Aboriginal and Torres Strait Islander people joining us today. First Nations Peoples should be aware that these videos may contain images or names of people who have died.]

[Artwork on screen: Possum Skin Cloak, Marcus Lee Design 2025]

[Text on screen: Pain Management]

[Text on screen: Darcy Banks, Senior Nurse]

Hi, my name is Darcy and I'm a senior nurse. Today, I'll be talking to you about pain management after surgery. Being worried about pain is normal and one of the most common reasons for anxiety before surgery. Discussing the topic of pain management beforehand can help reduce some of those fears.

It is important to acknowledge that after surgery, you should expect to have some degree of discomfort and pain. Following surgery, your pain will be managed by a team of experienced doctors and nurses or by a pain specialist with help from other specialties. Our goal is to reduce the pain that you have to a level that is manageable for you.

Well-managed pain lets you do your rehabilitation exercises such as coughing, moving, and ultimately helps you in getting out of hospital sooner.

Did you know that everybody has different abilities to cope with and manage pain? People with a similar procedure may have a different experience of pain to you. Every surgery and every person is different and your care team is trained to recognise these differences.

Why do we have pain after surgery? The main reason for pain is the actual surgery and the resulting injury to the body. That means that as the body heals the pain usually starts to reduce. However, not only the surgical procedure but also the positioning of the body during the operation can lead to aches and pains.

For example, following abdominal surgery, some patients experience discomfort when their bowel starts to move again. This is normal and a good thing, even though it can be uncomfortable. If you are already experiencing pain before your surgery, undergoing a long operation can make your pain worse for a short period of time.

Pain after surgery is expected but this is part of the recovery process and will reduce as you heal. Your care team will support you through this experience. Your care team will check the level of pain you are experiencing and how you are dealing with it. The nurses looking after you will also regularly ask you about your pain.

One of the ways we assess the level of pain is to ask you for a pain score. You'll be asked to rate your pain out of ten. Zero being no pain and ten being the worst pain that you could ever feel. Placing a number to your pain helps us to measure it. We will ask for your pain score each time we visit you after surgery.

One of the best ways for us to know how you are going with your pain is to see you moving and start to look after yourself. For example, we will ask you to do the ACBT routine to ensure that you can do this comfortably. This helps us to see if your pain is being managed well.

Now, let's talk about the common ways we can provide pain relief or analgesia. Your pain relief will be tailored to you after your surgery.

Now, I'll explain some of the most common interventions and some non-medical strategies that we use. During your operation, your anaesthetist will already administer different types of pain medication. Additional postoperative pain relief can be given in recovery should you need it and may consist of oral, intravenous or epidural methods.

Firstly, oral pain medication. The most commonly used form of pain medicines are oral tablets. These will be selected based on your needs. Your doctors may select a combination of simple medications like paracetamol and ibuprofen or strong medications like opioids to suit your needs.

If you are unable to have tablets, you may be given a PCA. PCA stands for patient controlled analgesia.

When the button is pushed, it delivers a small amount of pain medication through your drip. It is important that only you, the patient, pushes this button. There is an inbuilt safety mechanism so that you don't have to worry about too much medication going into your system.

Another type of pain relief is a spinal injection or an epidural infusion. This is performed via an injection in your lower back just before your operation. It works by numbing the nerves around the operation site. It may be offered as a single injection of a strong pain medication or, alternatively, a fine tube may be inserted to deliver a continuous local anaesthetic infusion and a strong painkiller for 24 hours. It is usually only required for a short period of time after surgery. After that, you'll be offered an alternative pain relief.

There are also some non-medical pain management strategies that you can try. Your care team may collaborate with physiotherapists, occupational therapists, and psychologists to ensure that you have pain management strategies that you can rely on in addition to medication such as movement, breathing and positioning.

Please see the other videos for more information on these topics.

When you leave hospital, it is normal to be given some oral medications to take home with you. Your pain should reduce over time, which will reduce your need for pain medications. This will be guided by your hospital care team and your local doctor.

Finally, let's talk about side effects. All medications can have side effects and it is not uncommon to experience these. That's why we regularly check for side effects.

Some of the common side effects of strong pain medications include nausea and vomiting, constipation, drowsiness and occasionally a rash or a feeling of itchiness across the body. Many patients are fearful of side effects such as fatigue or nausea. Nausea is one of the more common side effects of medication.

If you experience nausea, it is important to communicate this with your care team as anti-nausea medications or alternative pain medications can be offered to reduce this. This brings us to the end of this training on pain management.

You learned about the causes of surgical pain, how we commonly treat pain and you heard about the most common side effects of pain medication.

If you have any questions, please speak to your local team about your pain management strategy. We are here to support you throughout your pain management journey.

[Text on screen: Acknowledgements - Source material for this video has been provided by the Centre for Prehabilitation and Perioperative Care, Peter MacCallum Cancer Centre

• Prof. Bernhard Riedel, Director, Department of Anaesthesia, Perioperative and Pain Medicine
• Hilmy Ismail, Consultant Anaesthetist, Clinical Lead, Peter Mac Prehabilitation Service
• Ms Catherine Sinton, ERAS Clinical Nurse Consultant
• Darcy Banks, Senior Nurse

West Metro Health Services Partnership: Mercy Health, Peter Mac, The Royal Children's Hospital, The Royal Melbourne Hospital, Western Health, The Women's, North Western Primary Health Network]

[Text on screen: Disclaimer - The information contained in this video is for your general information and use only, and is not intended to be a substitute for independent professional advice and should not be used or relied on as an alternative to professional health care.

Please seek specific medical advice for your personal circumstances. If you require further information or have any questions related to the video content, please speak to your treating medical team.

If you are suffering from an acute illness or an emergency condition, please call Triple Zero (000).

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